Government spends Shs3,000 to treat each citizen monthly

Kampala. Government is on average spending Shs3,000 to provide healthcare services per citizen in a month, findings in the latest Annual Health Accounts (NHA) study by the Health ministry indicate.As a result, the report noted that more Ugandans have turned to the more expensive private health facilities for services, pushing up the cost of healthcare access.

The findings are based on an examination of the 2014/15 and 2015/16 financial years health sector expenses, and show the per capita expenditure on health is five-fold higher if household and donor contributions are included. Officials stated in the report titled; “Uganda Health Accounts: National Health Expenditure”, that the health expenditure per capita (inclusive of government, household and donor resources) on average for the two years under study was $51 (Shs188,700), reducing from $56 (Shs207,200) in the NHA previous studies.

This was mainly due to increase in population and large devaluation of the Ugandan shillings. NHA is an international technique for tracking financial flows in a country’s health sector, linking funds to sources and actual use to help inform national policy and decisions on who is picking the healthcare bills.

DeclineIts new survey shows that Uganda’s spend on each citizen’s health from government resources is down from $11 (Shs40,700) per year in 2013 to $10 (Shs37,000) even when both the country’s wealth and inflation figures are up.At the current level, the state expenditure on health is roughly one-third of the $34 (Shs126,000) recommended by the World Health Organisation (WHO) and less than the Health ministry’s own $17 (Shs63,000) minimum threshold spend specified in the Sector Development Plan (HSDP).“The $10 per capital expenditure by government means that Ugandans will not get quality health services and this explains why we have high mortality rates and high rates of hospital admissions,” Mr Tom Aliti, the Health ministry’s assistant commissioner for planning and development, also the UHA focal person, said at the release of the report yesterday.

As a result of low investment, Mr Aliti said most households have opted to seek healthcare from private providers as opposed to public facilities grappling with inadequate inputs such as medicines, diagnostic equipment and inadequate health workers. According to the study, one of every two households seeks health services from private providers as opposed to 13.5 who go to public facilities. The other expenditure heads, according to the report, are ambulatory healthcare, retail and other providers of medical goods and healthcare administration and financing.

Mr Aliti said the growing number of healthcare seekers is likely to prompt private hospitals to further increase their user fees to pay staff higher than their counterparts who receive salary raise this financial year. This, he added, will create a cyclical rise in healthcare costs.

According to the report, Uganda’s continued dependence on development partners is becoming increasingly doubtful because their contribution is unpredictable and has been reducing over the years.Donor contribution to the sector declined by about 2 percentage points between 2013 and 2016. However, the former vice president, and presidential adviser on health policy, Dr Specioza Kazibwe, said there is need to get rid of the donor dependency mentality.

“We need to do away with donor mentality. There is nothing for nothing and we are either paying indirectly or paying in-kind; so, let us begin talking about our money,” Dr Kazibwe said as she chaired the results dissemination meeting in Kampala. She also said government should end the current hemorrhage of public resources and abuse of health resources, citing annual spending on procurement of mosquito nets that recipients convert for, among other things, erecting temporary chicken pens and drying maize and cassava. “This information should help us strengthen the health financing strategy because compared to Rwanda, ours is medical financing instead of being health financing,” Dr Kazibwe said.

Her comment comes weeks after the government launched the annual National Physical Activity Day as part of its attempts to shift national health conversation and planning away from curative care to the cheaper prevention and health promotion. Dr Kazibwe said the $22 (Shs81, 500) household per capita expenditure in the report is likely a lower estimation, considering that building one improved pit latrine can cost a family Shs1.5m.

RecommendationsIn its recommendations, the report states that government should increase its allocation of resources to the health sector and introduce prepaid health financing mechanism such as social health insurance so as to increase its resource-base and avoid possible financial burden for households. In order to address the cash flow issues to health, Mr Aliti said: “We need to improve on efficiency and accountability by paying for results or what is referred as the results-based mechanisms.”Dr Gerald Mutungi, the head of Non-Communicable Diseases programme in the Health ministry, questioned whether the findings of the UHA are ever used to guide policy and budgeting.

He questioned why HIV/Aids continues to receive more funding, about 70.4 per cent of disease-based cost computations, yet NCDs deemed to be more prevalent are a footnote in resource allocation and expenditure. Mr Charles Sseruwajja, an official with the Inter-Religious Council of Uganda, expressed dissatisfaction that the government has not prioritised health promotion and as a result, invested less in disease prevention.

“I see silent modern day slavery. How can we still be fetching water from ponds?” Mr Sseruwajja asked in reference to lack of clean water sources for households, leading to water-borne and water-related diseases. “We need to bring our individuals on board to contribute to the health interventions so that Ugandans are responsible for their health,” he added.